“Selected Proposals to Reform the U.S. HealthCare System.
“LEFT-LEANING PROPOSALS

“Medicare Extra for All”
“Example: Proposal by Center for American Progress, “Medicare Extra for All” [26]. Provides universal coverage in part by expanding the Medicare program to anyone who chooses to join, as well as all newborns and individuals turning age 65 – who are automatically enrolled. Employers have the choice of continuing to provide coverage, or enrolling their employees into Medicare Extra. Has broad benefits package including dental, vision, and hearing services. Cost sharing requirements and premiums are income-related and free for those below 150% of the poverty level. Provider payment rates are the same irrespective of the source of patient insurance coverage, and are based on current Medicare fee levels. Government would negotiate prescription drug prices. It is to be financed through employer contributions, income-related premiums, and taxes on high-income individuals.

“Single Payer Example: Proposal by Senator and 2016 Democrat presidential candidate Bernie Sanders [29]. Provides universal coverage by creating a single, public insurance system. Care would be free at point of service, and cover “the entire continuum of health care.” Likely to be financed through employer premium payments, income-based household premium payments, and federal income taxes.

“RIGHT-LEANING PROPOSALS

“State-Based Block Grants and Spending Caps
“Example: Graham-Cassidy, H.R. 1628 [27]. Proposal to repeal and replace the Affordable Care Act. It was not passed by the U.S. Congress. The bill contained many provisions, including allowing insurers to sell plans not compliant with the ACA’s mandatory benefit package, and allowing insurers to sell across state lines. A key component of the proposal calls for block grants to states, replacing ACA premium subsidies and funds allotted to the Medicaid expansion. It allows states to devise alternative ways of subsidizing and regulating coverage. States can use the grants “to expand their Medicaid programs . . ., establish high-risk pools, provide premium and cost-sharing assistance to insurance enrollees, make direct payments to insurers, and pay health care providers. . .” [28]It would also cap growth in Medicaid based on an annual per capita federal contribution. Contribution increases are limited to the growth in medical inflation for children and adults,and CPI + 1% for the disabled and seniors until 2025; there-after annual increases for the two groups would be limited to general inflation and medical inflation rates, respectively.

“Health Savings Accounts (HSAs)
“Various modifications to U.S. laws regarding HSAs have been proposed as part of Republican legislative bills to reform healthcare. Examples include: (a) doubling annual contribution caps; (b) allowing spouses age 50 and older to make additional“catch up” contributions; (c) allow HSAs be used to pay for over-the-counter medications; (c) reducing penalties for HSA distributions made before the age of 65; and (e) allowing HSA funds to be used for medical expenses incurred up to 60 days before establishment of the HSA [30].”

Source: Thomas Rice, Lynn Y. Unruh, Ewout van Ginneken, Pauline Rosenau, Andrew J. Barnes, Universal coverage reforms in the USA: From Obamacare through Trump, Health Policy, Volume 122, Issue 7, 2018, Pages 698-702, ISSN 0168-8510, https://doi.org/10.1016/j.healthpol.2018.05.007. http://www.sciencedirect.com/science/article/pii/S0168851018301544